2. RELATED FEDERAL AVIATION REGULATIONS, FAA ADVISORY CIRCULARS AND FAA ORDERS. a. 14 CFR part 21, Certification Procedures for Products and Parts.

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1 ADVISORY CIRCULAR AC No: Date: 4/3/96 Change: Initiated by: AIR-200 Subject: AMATEUR-BUILT AIRCRAFT 1. PURPOSE. This advisory circular (AC) explains current Federal Aviation Regulations (FAR) and Federal Aviation Administration (FAA) policy for the fabrication and assembly of amateur-built aircraft. It provides information and guidance to persons involved in the construction of amateur-built aircraft, the manufacture of kits designed to be assembled into aircraft by amateur-builders, builders of aircraft fabricated from plans for certification as amateur-built, and persons providing assistance to amateur-builders. Like all AC material, this AC is not mandatory and does not constitute a regulation. It is issued for guidance purposes and to outline a method of compliance with the applicable FAR. In lieu of following this method without deviation, a person may elect to follow an alternate method, provided the alternate method is also found by the FAA, to be an acceptable means of complying with the requirements of the FAR. Since the method of compliance presented in this AC is not mandatory, the terms "shall" and "must" used herein apply only to a person who chooses to follow this particular method without deviation. This AC does not change regulatory requirements and does not authorize changes in, or deviations from, regulatory requirements. 2. RELATED FEDERAL AVIATION REGULATIONS, FAA ADVISORY CIRCULARS AND FAA ORDERS. a. 14 CFR part 21, Certification Procedures for Products and Parts. b. 14 CFR part 65, Certification: Airman other than Flight Crewmembers. c. Advisory Circular 20-27, Certification and Operation of Amateur-Built Aircraft.

2 P S Advisory Circular # Page: 2 ============================ Text Page 2 of 23 ================================ d. Advisory Circular 65-23, Certification of Repairmen (Experimental Aircraft Builders). e. Advisory Circular 90-89, Amateur-Built Aircraft and Ultralight Flight Testing Handbook. f. FAA Order , Airworthiness Certification of Aircraft and Related Products. 3. BACKGROUND. a. The FAR provides for the issuance of a special airworthiness certificate in the experimental category for the purpose of operating amateur-built aircraft. Title 14 CFR part 21, section (g), defines an amateur-built aircraft as "an aircraft THE MAJOR PORTION of which has been FABRICATED AND ASSEMBLED BY PERSONS who undertook the construction project SOLELY FOR THEIR OWN EDUCATION OR RECREATION" (emphasis added). b. The FAA, in partnership with the Experimental Aircraft Association (EAA) and the Small Aircraft Manufacturers Association (SAMA), saw a need to address the practice of fabrication and assembly of amateur-built aircraft for profit. The aircraft were designed as kits and/or plans-built, with the intent that they would be constructed by amateur-builders for their own education or recreation. 4. DEFINITIONS. As used in this advisory circular, the following definitions apply: a. Aircraft Evaluation. The evaluation performed for the purpose of determining if a specific amateur-built aircraft meets the major portion requirement of section (g). b. Builder Center. A place where amateur-builders can obtain instruction, help, and support during construction of their aircraft. c. Commercial Assistance. Assistance in the building of an amateur-built aircraft in exchange for compensation. This does not include one builder helping another. d. Compensation. Payment by the amateur-builder applicant in cash, services, or other tender, to any person who provides assistance on a commercial basis in the building of an aircraft. e. Checklist. The FAA Form , Fabrication/Assembly

3 P S Advisory Circular # Page: 3 ============================ Text Page 3 of 23 ================================ Operation Checklist, is used by the FAA as an aid in determining if a manufacturer's aircraft kit meets the major portion requirements of section (g). It is also used for determining if a completed aircraft is eligible for certification as an amateur-built aircraft (sample in appendix 1). f. Kit-Built Aircraft. An aircraft that is constructed from a manufactured kit that may include some major sub-assemblies and/or pre-assembled components. g. Kit Evaluation. An evaluation by the FAA to determine if an aircraft built from, and according to, the kit instructions will meet the major portion requirement of section (g). h. Letter of Eligibility. A letter provided by the FAA to an aircraft kit manufacturer advising that the aircraft kit requested to be evaluated meets the major portion requirement of section (g). i. Major Portion. As related to a special airworthiness certificate issued for the purpose of operating amateur-build aircraft, major portion means that when the aircraft is completed, the majority of the fabrication and assembly tasks have been performed by the amateur builder(s) who submit the application for certification. j. Person. An individual, firm, partnership, corporation, company, association, joint-stock association, or governmental entity. It includes a trustee, receiver, assignee, or similar representative of any of them. k. Plans-Built Aircraft. An aircraft that is constructed exclusively from plans/blueprints without the aid of purchased major sub-assemblies or preassembled kit components. This also includes aircraft of a builder's original design. l. Unacceptable Commercial Assistance. Any commercial assistance that reduces the work performed by the amateur-builder to less than the major portion of the aircraft construction. 5. EVALUATION OF KITS, COMPLETED KIT-BUILT, AND PLANS-BUILT AIRCRAFT. The evaluation to determine compliance with the major portion construction requirement of the FAR is usually performed by an FAA Aviation Safety Inspector (ASI) from a Manufacturing Inspection District Office (MIDO) or a Flight Standards District Office (FSDO). Additionally, a Designated Airworthiness Representative (DAR) may be authorized to evaluate a completed plans-built aircraft intended for certification as an

4 P S Advisory Circular # Page: 4 ============================ Text Page 4 of 23 ================================ amateur-built. a. Initial Evaluation of Kits. (1) Aircraft kit manufacturers requesting a kit evaluation should submit a letter to the local FAA Manufacturing office. The purpose of the evaluation is to determine if the completed aircraft is capable of meeting the major portion requirements of section (g). (2) When the kit is evaluated using the checklist as a guide and found to comply with the major portion requirement of section (g), a Letter of Eligibility is sent to the kit manufacture. The kit is then acceptable to be included in the Listing of Eligible Amateur-Built Aircraft Kits. This letter SHOULD NOT be construed to mean the kit or its manufacturer is FAA certified, certificated, or approved, and it is not appropriate to represent it as such. (3) The listing is published by the FAA's Engineering and Manufacturing Branch, AFS-610, P.O. Box 25082, Oklahoma City, OK 73125, telephone number, (405) This information is also available in electronic format through Fed World in Springfield, VA by calling (703) or through the internet via: http// The purpose of the listing is to assist the amateur-builder, the ASI, or the DAR by eliminating the duplication or evaluations for the major portion determination. (4) If the kit manufacturer later offers an option or makes changes to the kit that decreases the amount of fabrication and assembly required by the builder, the manufacturer should request a new Letter of Eligibility. The kit manufacturer would provide a revised checklist and a description of the option or change to the FAA with drawing and/or photos as necessary. If the FAA determines that the revised kit still meets the major portion requirement, the FAA will issue a new Letter of Eligibility for the amended checklist without conducting a physical inspection or complete re-evaluation of the kit. If the FAA determines that the option or change was of sufficient magnitude, a physical inspection and re-evaluation of the kit will be performed. b. Completed Kit-Built Aircraft. When a kit has been evaluated and published in the listing of eligible amateur-built aircraft kits, and no commercial assistance was used in the construction of the aircraft using the evaluated kit, the ASI or DAR will not be required to make another major portion rule

5 P S Advisory Circular # Page: 5 ============================ Text Page 5 of 23 ================================ determination for the completed aircraft. c. Plans-Built Aircraft. (1) During final inspection for compliance with section (g), a plans-built aircraft must be evaluated using the FAA Form as a guide. If the builder intends to utilize commercial assistance, the FAA Form can be submitted to the FAA prior to construction, listing the tasks or processes for which the commercial assistance is proposed. It should also show the intended fabrication and assembly tasks the builder will perform. On the basis of this pre-construction checklist, a builder of a plans-built aircraft should be able to obtain an evaluation in writing from the ASI or DAR of the effect that the proposed commercial assistance will have on the major portion requirement for the completed aircraft. (2) A person may provide commercial assistance to a builder of a plans-built aircraft or non-evaluated kit. This assistance or task must be listed in the KIT MANUFACTURER column on the checklist when the completed aircraft is presented for evaluation/certification to the ASI or DAR. 6. COMMERCIAL ASSISTANCE NOT REQUIRING RE-EVALUATION OF THE COMPLETED AIRCRAFT. a. Commercial instructional assistance may be obtained by the amateur builder in the fabrication or assembly of specific parts and the completion of certain tasks or processes involved in the construction of the aircraft. During all instructional activity, the amateur-builder must be present to accomplish the tasks and all subsequent fabrication and assembling of parts for which commercial instruction is being rendered. Tasks completed by the amateur-builder would be identified on the FAA Form under AMATEUR or in the assembly manual. For example, assume fabrication of the wing ribs is listed on the checklist or in the assembly manual as a task required to be completed by the amateur-builder. Instructional activity could be provided to build the first few ribs with the remainder to be completed by the amateur-builder. b. Commercial assistance may be obtained for non-checklist items on a kit that has been evaluated by the FAA. A non-checklist item is a task or process that is not listed in the checklist. These items also include painting and the installation of interior upholstery or avionics beyond basic regulatory requirements. Such a task or process would not be required to be personally completed by the amateur-builder for

6 P S Advisory Circular # Page: 6 ============================ Text Page 6 of 23 ================================ the aircraft to receive an airworthiness certificate under section (g). c. The amateur-builder is not expected to have fabricated every component that makes up the completed aircraft. Non-checklist items include the fabrication of the engines, propellers, wheels and brake assemblies, and standard aircraft hardware. The installation of these items may be required to be accomplished by the builder if they are checked in the AMATEUR column on the checklist. 7. Commercial Assistance Requiring Re-evaluation of the Completed Aircraft. If commercial assistance other than that described in paragraph 6 is performed on the items listed in the checklist under AMATEUR, on a evaluated kit, the major portion evaluation previously performed by the FAA will be invalid for that specific aircraft project. Consequently, it may result in a complete re-evaluation of the fabrication and assembly of that aircraft. This could put the amateur-built status of the aircraft in jeopardy. In other words, the aircraft will be treated as a non-evaluated kit and subject to complete evaluation by the FAA when presented for certification as an amateur-built aircraft. The builder may want to obtain a pre-construction evaluation of proposed commercial assistance in writing from the ASI or DAR to preclude certification problems at the completion of a project. 8. Commercial Assistance on Incomplete Aircraft. Commercial assistance does not include the instance where an incomplete aircraft is sold to another builder and the second or subsequent builder completes the aircraft. In such a case, the work performed by the first builder will count toward completion of the major portion by the second builder. The second or subsequent builder should obtain as much detailed information and documentation, e.g., logbooks, material receipts, pictures, etc., from the original builder as possible. This information will be helpful in the FAA's determination for the major portion requirement of the aircraft and eligibility of the subsequent builder to meet the requirement for repairman certification under section The second builder may not be eligible for a repairman certificate under section , unless it can be shown to the satisfaction of the FAA that the individual has the requisite skill to determine whether the aircraft is in a condition for safe operation. 9. Non-Evaluated Kit Aircraft. An aircraft constructed from a non-evaluated kit must be evaluated upon completion for compliance with section (g), by the ASI or DAR using the

7 P S Advisory Circular # Page: 7 ============================ Text Page 7 of 23 ================================ procedures in the FAA Order , Airworthiness Certification of Aircraft and Related Products, and the FAA Form , as a guide. 10. ADDITIONAL INFORMATION. The FAA Form , Eligibility Statement, is one of the forms required to be submitted by the applicant for a special airworthiness certificate for the purpose of operating an amateur-built aircraft. It includes sections for the registered owner and aircraft information along with the applicant's declaration certifying that all statements and answers are complete and true. It also provides notice of the potential penalty that could be applied if false or fraudulent statements are made. A sample of the FAA Form is located in appendix INFORMATION SUPPLIED BY INDUSTRY TO PROSPECTIVE CUSTOMERS. Kit manufacturers are encouraged to include a document explaining the intent and purpose of the amateur-built rule in their information packages. Prospective customers would then be made aware of their responsibility and limitations under the FAR. The information package should summarize the process used to determine kit eligibility and the inspection of the completed aircraft. It should also advise potential builders of the statement they must sign certifying that they fabricated and assembled the major portion of the aircraft. Additionally, the customer should be advised of the need for and the availability of flight training, as well as the value of participation in the EAA Flight Advisor Program. 12. INFORMATION SUPPLIED BY INDUSTRY TO PURCHASERS. Kit manufacturers are encouraged to include a copy of the amateur-built regulation and to advise the purchaser of the requirement for the applicant to certify that they fabricated and assembled the major portion of the aircraft for their own education or recreation. In addition to the aircraft assembly manual, the kit manufacturer should reference this AC regarding acceptable commercial assistance and the use of a builder center for help and instruction during construction of an aircraft. The manufacturers should inform purchasers of the help available to them through various EAA programs, including: EAA Chapters, Technical Counselors, and Flight Advisors. /s/ Frank P. Paskiewicz Acting Manager, Production and Airworthiness Certification Division APPENDIX 1. PREPARATION INSTRUCTIONS FOR

8 P S Advisory Circular # Page: 8 ============================ Text Page 8 of 23 ================================ FAA FORM , FABRICATION/ASSEMBLY OPERATION CHECKLIST 1. PURPOSE. This appendix provides instructions for completing FAA Form A sample form is included as figure GUIDANCE. This form may be used by any person to establish the eligibility of an aircraft to be certificated experimental, for the purpose of operating as an amateur-built. Prepare the form as follows: a. Enter the company name and address, aircraft model, (by name and/or number), document name and date (manufacturer's parts list, assembly manual, etc., with latest revision) and type of aircraft (land, sea, fixed-wing, rotorcraft, etc.). b. Mark the specific tasks required to fabricate and assemble the aircraft. Mark, an "X" under the column heading "Accomplished By" in the appropriate space when the task is performed by the AMATEUR. If the task is performed by the kit manufacturer or by a person providing commercial assistance, a mark will be placed in the KIT MANUFACTURER column. Additional blank lines are provided to list any tasks not on the checklist. If a task is listed and not applicable to the construction of the aircraft enter N/A in the appropriate space. c. Use the comments area to enter any additional comments, information or statements, as necessary. d. Print or type name of person performing the evaluation of the kit or aircraft. e. The person performing the evaluation of the kit or aircraft should sign their name in the signature block. f. Enter the date the evaluation was performed FIGURE 1. SAMPLE FAA FORM , FABRICATION ASSEMBLY OPERATION CHECKLIST Fabrication/Assembly Operation Checklist Company Name Address

9 P S Advisory Circular # Page: 9 ============================ Text Page 9 of 23 ================================ Aircraft Model Document Name and Date Type of Aircraft Accomplished By Kit manufacturer Amateur FUSELAGE 1. Fabricate Special Tools or Fixtures 2. Fabricate Longitudinal Members, Cores or Shells 3. Fabricate Bulkheads or Cross Members 4. Assemble Fuselage Basic Structure 5. Fabricate Brackets and Fittings 6. Install Brackets and Fittings 7. Fabricate Cables, Wire, and Lines 8. Install Cables, Wires, and Lines 9. Fabricate Fuselage Covering or Skin 10. Install Fuselage Covering or Skin 11. Fabricate Windshield/Windows/ Canopy

10 P S Advisory Circular # Page: 10 ============================ Text Page 10 of 23 =============================== 12. Install Windshield/Windows/ Canopy WINGS 1. Fabricate Special Tools or Fixtures 2. Fabricate Wing Spars 3. Fabricate Wing Ribs or Cores 4. Fabricate Wing Leading and Trailing Edge 5. Fabricate Drag/Anti-Drag Truss Members 6. Fabricate Wing Brackets and Fittings 7. Fabricate Wing Tips 8. Assemble Basic Wing Structures 9. Install Wing Leading/Trailing Edge and Tips 10. Install Drag/Anti-Drag Truss 11. Fabricate Cables, Wires, and Lines

11 P S Advisory Circular # Page: 11 ============================ Text Page 11 of 23 =============================== 12. Install Cables, Wires, and Lines 13. Fabricate Wing Covering or Skin 14. Install Wing Covering or Skin 15. Fabricate Wing Struts/Wires 16. Install and Rig Wings, and Struts FLIGHT CONTROLS 1. Fabricate Special Tools or Fixtures 2. Fabricate Aileron Spars 3. Fabricate Aileron Ribs or Cores 4. Assemble Aileron Structure 5. Fabricate Aileron Leading and Trailing Edge 6. Assemble Aileron Leading and Trailing Edge 7. Fabricate Aileron Brackets and Fittings 8. Install Aileron Brackets and Fittings

12 P S Advisory Circular # Page: 12 ============================ Text Page 12 of 23 =============================== 9. Fabricate Aileron Covering or Skin 10. Install Aileron Covering or Skin 11. Fabricate Aileron Trim Tab 12. Install Aileron Trim Tab 13. Install and Rig Aileron 14. Fabricate Flap Spars 15. Fabricate Flap Ribs or Cores 16. Assemble Flap Structure 17. Fabricate Flap Leading and Trailing Edge 18. Assemble Flap Leading and Trailing Edge 19. Fabricate Flap Brackets and Fittings 20. Install Flap Brackets and Fittings 21. Fabricate Flap Covering or Skin 22. Install Flap Covering or Skin 23. Install and Rig Flap 24. Fabricate Elevator Spars 25. Fabricate Elevator Ribs or Cores 26. Assemble Elevator Structure 27. Fabricate Elevator Leading and Trailing Edge 28. Assemble Elevator Leading and

13 P S Advisory Circular # Page: 13 ============================ Text Page 13 of 23 =============================== Trailing Edge 29. Fabricate Elevator Brackets and Fittings 30. Install Elevator Brackets and Fittings 31. Fabricate Elevator Covering or Skin 32. Install Elevator Covering or Skin 33. Fabricate Elevator Trim Tab 34. Install Elevator Trim Tab 35. Install and Rig Elevator 36. Fabricate Rudder Spars 37. Fabricate Rudder Ribs or Cores 38. Assemble Rudder Structure 39. Fabricate Rudder Leading and Trailing Edge 40. Assemble Rudder Leading and Trailing Edge 41. Fabricate Rudder Brackets and Fittings 42. Install Rudder Brackets and Fittings 43. Fabricate Rudder Covering or Skin 44. Install Rudder Covering or Skin 45. Fabricate Rudder Trim Tab 46. Install Rudder Trim Tab 47. Install and Rig Rudder

14 P S Advisory Circular # Page: 14 ============================ Text Page 14 of 23 =============================== EMPENNAGE 1. Fabricate Special Tools of Fixtures 2. Fabricate Spars 3. Fabricate Ribs or Cores 4. Fabricate Leading and Trailing Edges 5. Fabricate Tips 6. Fabricate Brackets and Fittings 7. Assemble Empennage Structures 8. Install Leading/Trailing Edges and Tips 9. Install Fittings 10. Fabricate Cables, Wires, and Lines 11. Install Cables, Wires and Lines 12. Fabricate Empennage Covering or Skin 13. Install Empennage Covering or Skin

15 P S Advisory Circular # Page: 15 ============================ Text Page 15 of 23 =============================== CANARD 1. Fabricate Canard 2. Assemble Canard Structure 3. Install and Rig Canard LANDING GEAR 1. Fabricate Special Tools or Fixtures 2. Fabricate Struts 3. Fabricate Brakes System 4. Fabricate Retraction System 5. Fabricate Cables, Wires and Lines 6. Assemble Wheels, Brakes, Tires, Landing Gear

16 P S Advisory Circular # Page: 16 ============================ Text Page 16 of 23 =============================== 7. Install Landing Gear System Components PROPULSION 1. Fabricate Special Tools of Fixtures 2. Fabricate Engine Mount 3. Fabricate Engine Cooling System/Baffles 4. Fabricate Induction System 5. Fabricate Exhaust System 6. Fabricate Engine Controls 7. Fabricate Brackets and Fittings 8. Fabricate Cables, Wires and Lines 9. Assemble Engine 10. Install Engine and Items Listed Above 11. Fabricate Engine Cowling 12. Install Engine Cowling 13. Fabricate Propeller 14. Install Propeller 15. Fabricate Fuel Tank

17 P S Advisory Circular # Page: 17 ============================ Text Page 17 of 23 =============================== 16. Install Fuel Tank 17. Fabricate Fuel System Components 18. Install Fuel System Components MAIN ROTOR DRIVE SYSTEMS AND CONTROL MECHANISM(S) 1. Fabricate Special Static and Dynamic Main Rotor Rigging Tools 2. Fabricate/Assemble Main Rotor Drive Train 3. Install Main Rotor Drive Train Assembly 4. Fabricate/Assemble Main Rotor Shaft and Hub Assembly 5. Install Main Rotor Shaft and Hub Assembly 6. Align Main Rotor Shaft Drive Train, Shaft and Hub Assembly 7. Fabricate Main Rotor Rotating Controls 8. Install Main Rotor Rotating Controls 9. Fabricate Main Rotor Non-Rotating Controls

18 P S Advisory Circular # Page: 18 ============================ Text Page 18 of 23 =============================== 10. Rig Main Rotor Rotating and Non-Rotating Controls 11. Fabricate Main Rotor Blades 12. Install Main Rotor Blades on Rotor Hub 13. Statically Balance and Rig Main Rotor System 14. Dynamically Track and Balance Main Rotor System TAIL ROTOR DRIVE SYSTEMS AND CONTROL MECHANISM(S) 1. Fabricate Special Static Tail Rotor Rigging Tools 2. Fabricate Vertical Trim Fin 3. Install Vertical Trim Fin 4. Fabricate Horizontal Stabilizer 5. Install Horizontal Stabilizer 6. Fabricate Tail Rotor Drive System 7. Install Tail Rotor Drive System 8. Fabricate Tail Cone or Frame

19 P S Advisory Circular # Page: 19 ============================ Text Page 19 of 23 =============================== 9. Install and Rig Tail Cone or Frame 10. Rig Vertical Trim Fin 11. Fabricate Tail Rotor Shaft and Hub Assembly 12. Install Tail Rotor Shaft and Hub Assembly 13. Fabricate Tail Rotor Rotating and Non-Rotating Controls 14. Rig Tail Rotor Rotating and Non-Rotating Controls 15. Fabricate/Assemble Tail Rotor Blades 16. Install Tail Rotor Blades 17. Statically Balance and Rig Tail Rotor System 18. Dynamically Track and Balance Tail Rotor System COCKPIT/INTERIOR 1. Fabricate Instrument Panel 2. Install Instrument Panel and Instruments

20 P S Advisory Circular # Page: 20 ============================ Text Page 20 of 23 =============================== 3. Fabricate Seats 4. Install Seats 5. Fabricate Electrical Wiring, Controls/Switches 6. Install Electrical System Controls/Switches TOTAL Comments Printed Name Signature Date APPENDIX 2. PREPARATION INSTRUCTIONS FOR FAA FORM , ELIGIBILITY STATEMENT AMATEUR-BUILT AIRCRAFT 1. PURPOSE. This appendix provides instructions for completing FAA Form A sample form is included as figure GUIDANCE. This form is required to be submitted by a person applying for a special airworthiness certificate, experimental, for the purpose of operating an amateur-built aircraft under section (g). Prepare the form by inserting in: a. SECTION I. REGISTERED OWNER INFORMATION: Enter the

21 P S Advisory Circular # Page: 21 ============================ Text Page 21 of 23 =============================== name, address, and telephone number for residence and place of business. b. SECTION II. AIRCRAFT INFORMATION: Enter the model (number and/or name), assigned serial number, registration number, whether aircraft was fabricated from a plan or kit, engine make, engine serial number, prop/rotor make, prop/rotor serial number. c. SECTION III. MAJOR PORTION ELIGIBILITY STATEMENT OF APPLICANT: The name of person(s) (printed), identified in Section I that certify the aircraft identified in Section II on the form was fabricated and assembled for their own education or recreation. The applicant should sign (in ink), and enter the date signed. d. SECTION IV. NOTARIZATION STATEMENT: The signature, date, and stamp (if applicable), of a Notary Public who witnessed the signature of the applicant. APPENDIX 2. SAMPLE FAA FORM , ELIGIBILITY STATEMENT AMATEUR-BUILT AIRCRAFT Form Approved O.M.S. NO Instructions: Print U.S. Department ELIGIBILITY STATEMENT or type all information of Transportation AMATEUR-BUILT AIRCRAFT except signature. Submit original to an Federal Aviation Administration authorized FAA representative. Applicant completes Section I thru III. Notary Public Completes Section IV. I. REGISTERED OWNER INFORMATION Name(s) Address(es) No. & Street City State Zip

22 P S Advisory Circular # Page: 22 ============================ Text Page 22 of 23 =============================== Telephone No.(s) ( ) ( ) Residence Business II. AIRCRAFT INFORMATION Model Engine(s) Make Assigned Serial No. Engine(s) Serial No.(s) Registration No. Prop/Rotor(s) Make Aircraft Fabricated: Plan _ Prop/Rotor(s) Serial No.(s) Kit _ III. MAJOR PORTION ELIGIBILITY STATEMENT OF APPLICANT I certify the aircraft identified in Section II above was fabricated and assembled by Name of Person(s) (Please Print) for my (their) education or recreation. I (we) have records to support this statement and will make them available to the FAA upon request. -- NOTICE -- Whoever in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, conceals or covers up by any trick, scheme, or device a material fact, or who makes any false, fictitious or fraudulent statements or representations, or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than 5 years, or both (U.S. Code, Title 18, Sec ) APPLICANT'S DECLARATION I hereby certify that all statements and answers provided by me in this statement form are complete and true to the best of my knowledge, and I agree that they are to be considered part of the basis for issuance of any FAA certificate to me. I have also read and understand the Privacy Act statement that accompanies this form. Signature of Applicant (In Ink) Date

23 P S Advisory Circular # Page: 23 ============================ Text Page 23 of 23 =============================== IV. NOTARIZATION STATEMENT

24 P S Advisory Circular # Page: 24 Status: Active Originator: AIR-200 ========================== C r i t e r i a =========================== Doc is REPLACED BY the following: (none) Doc REPLACES the following: (none) Rule Type Rule Type Rule Type FAR FAR FAR FAR